Informed consent: implementing shared decision-making in health care

Informed consent has been proposed to encourage patient participation in medical decision-making. Informed consent is commonly operationalized as a two phase process of receiving information and making a decision by the patient. Currently, computers are introduced to sustain informed consent. The programmes used, so-called Shared Decision-making Programmes (SDP’s), are based upon the standard model of informed consent, focussing on information disclosure and patient decision-making. We argue that this view of informed consent is too narrow to do justice to actual proceses of negotiation in health care. We propose a more refined model of informed consent, in which processes of communication play a pivotal role. On the base of Habermas’ theory of communicative action, we propose that decision aids should not only support information disclosure, but also processes of communication and joint decision-making.